The Golden Hour

[aussiephil]

Dear Reverend:

So change the "scenario" just a bit, as in there is no Trauma Center to Load and Scoot TOO. Well accept for an intermediate level of care and basic clinic with very outdated diagnostic equipment and lucky if you can find an xray tech, this this within (3 hours by ground) as Helos do not fly here at night (well yet) and then an additional 2-3 hours by Air (fixed wing)to the almighty Trauma Center.

So are we educated enough or have enough of the right type of equipment for an accurate dx or give treatment that will not make blood into kool aid, should we stick to our Load and Go philosophy or look for ways to improve care, just saying when faced with this situation one is forced to look to other philosophic means to solve the problem.

This is a very realistic situation that I find myself in and daily when I am remotely deployed and then I hear the "Golden Hour" quoted by the clowns in safety and Medical Directors (that are located a thousand miles away) those that dictate and limit my actions and treatment options.

Any positive Ideas as to how to improve chances of survival for my patients, besides tranexamic acid, volume expanders, or Hypertonic Saline + .

Just trying to think outside the "Golden Hour" or "Load and Go" box.

I wish to introduce the term "Canadian Silver Six"

cheers

Reverend Dr Turnip,

I face the same situation on a regular basis here myself. This does not alter the fact that the patient, especially in the extreemes of cold that you face in the place you are, is acontrolled environment. One that can provide some fluid resus as needed.

In these environments, we need more than paramedics, we need Paramedics trained to work with a trauma centre. One of the initiatives that is being implemented here, considering a Trauma Centre can be 400Km from the incident with no aero back up, is internet based video conferencing. This puts equipment into the smaller hospitals, with the diagnostics available in real time to the trauma team in some cases, 1000Km away to make the most appropriate decisions for that patient.

My point, Reverend Dr Turnip is to delay time on scene, to delay moving a patient to more difinitive care because a Paramedic has too big an ago, is putting patients at risk.

Phil